The Weekly Scan

February 22, 2019

Last Updated: 1:00 PM EST

Litigation

  • Texas Attorney General Ken Paxton announced Tuesday that Xerox Corporation and several of its former subsidiaries – including Conduent, Inc. – agreed to a $235.9 million settlement with the State of Texas to resolve a lawsuit brought under the Texas Medicaid Fraud Prevention Act (TMFPA) and other grounds regarding the processing of prior authorization requests by dentists to deliver orthodontic services to Medicaid patients. The announced settlement represents the largest single resolution in a case filed by the attorney general’s office for Medicaid-related claims. (TexasAttorneyGeneral.gov)

 

  • Health care giant UPMC struck back at the Pennsylvania attorney general on Thursday, accusing him in a nine-count civil lawsuit of “illegally taking over nonprofit health care” in the state. The federal court lawsuit, which seeks class-action status, came in response to a petition that Attorney General Joshua Shapiro filed Feb. 7 in Commonwealth Court seeking to force UPMC into contracting with all health insurers while meeting its charitable obligations as a nonprofit medical institution. The attorney general’s attempt to amend agreements governing the wind-down of relations between Pittsburgh’s two largest health care operators, Highmark and UPMC, is unconstitutional, according to UPMC’s court filing. “This illegal scheme fundamentally changes the law,” UPMC said in the lawsuit. “General Shapiro’s assertion of ‘vast’ power over nonprofits also violates the United States Constitution.” (Post-Gazette.com)

 

  • Attorney General Andy Beshear is returning more than $5 million to the Kentucky Medicaid program from a settlement with Fresenius Medical Care Holdings Inc. over allegations of Medicaid fraud.

    The settlement resolves claims by Beshear that the Massachusetts-based company violated Medicaid guidelines by failing to warn Kentucky dialysis clinics and doctors from 2003-2012 that its kidney dialysis product, GranuFlo, could result in dangerously increased bicarbonate levels. Beshear said clinics and doctors needed to know the risks of increased bicarbonate levels from GranuFlo in order to properly treat patients and to not put them at harm. “These allegations against Fresenius are very serious, and were not taken lightly by my office,” Beshear said. “I do commend the company for working with us on a settlement that will give millions to the state’s Medicaid program that helps provide health care to hundreds of thousands of adults and children in Kentucky.” (Kentucky.gov)

Legislation

  • A proposal to allow Gov. Brian Kemp to pursue Medicaid waivers from the federal government was approved by a Georgia Senate committee Tuesday. The Senate Health & Human Services Committee voted 9-4 to approve a bill authorizing Kemp's office to pursue the waivers after lawmakers sped through testimony and questions in a one-hour meeting. A federal waiver, as opposed to a full Medicaid expansion backed by Democrats, would give Georgia the flexibility to adopt a more conservative plan. Kemp praised the committee's vote in a statement, saying it would help improve health care access, decrease insurance premiums and enhance the quality of care for Georgia's families. "This legislation will allow state officials to craft a Georgia-centric health care plan that ensures a bright and healthy future for our state," Kemp said. (NewsChannel9.com)

 

  • Top congressional Democrats are calling on the Trump administration to stop approving work requirements for Medicaid programs after more than 18,000 people lost coverage last year due to the requirements in Arkansas. House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) and Senate Finance Committee ranking member Ron Wyden (D-Ore.) wrote to the administration on Tuesday asserting that the requirements “threaten to impede access to critical care for millions of Americans.” “We unfortunately are now seeing these concerns play out in real life in the state of Arkansas where thousands of individuals have been forced off and locked out of their Medicaid coverage,” they added in the letter to Secretary of Health and Human Services Alex Azar. (TheHill.com, Finance.Senate.gov)

 

Medicare & Medicaid 

  • National health expenditure growth is expected to average 5.5% annually from 2018-2027, reaching nearly $6.0 trillion by 2027, according to a report published Wednesday by the independent Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). Growth in national health spending is projected to be faster than projected growth in Gross Domestic Product (GDP) by 0.8 percentage points over the same period.  As a result, the report projects the health share of GDP to rise from 17.9% in 2017 to 19.4% by 2027. The outlook for national health spending and enrollment over the next decade is expected to be driven primarily by, key economic factors, such as growth in income and employment, and demographic factors, such as the baby-boom generation continuing to age from private insurance into Medicare; and increases in prices for medical goods and services (projected to grow 2.5% over 2018-2027 compared to 1.1% during the period of 2014-2017). (CMS.gov)

 

  • The Office of Inspector General at the Department of Health and Human Services published a new report titled "CMS Improperly Paid Millions of Dollars for Skilled Nursing Facility Services When the Medicare 3-Day Inpatient Hospital Stay Requirement Was Not Met." A summary from the HHS website explains: "According to Federal law, to be eligible for coverage of posthospital extended care services, a Medicare beneficiary must be an inpatient in a hospital for not less than 3 consecutive calendar days (3-day rule) before being discharged from the hospital. CMS improperly paid 65 of the 99 skilled nursing facility (SNF) claims we sampled when the 3-day rule was not met. Improper payments associated with these 65 claims totaled $481,034. On the basis of our sample results, we estimated that CMS improperly paid $84 million for SNF services that did not meet the 3-day rule during 2013 through 2015. We attribute the improper payments to the absence of a coordinated notification mechanism among the hospitals, beneficiaries, and SNFs." (OIG.HHS.gov)

 

 

 

 

 

 

 

 

 

 

 

 

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